Services

The Centre provides unbiased drug information to meet the needs of the practicing physicians, pharmacists and other health care professionals. Drug Information Centre work towards in promotion of safe, effective, rational and economic use of drugs by the health professionals and patients.

Setup of independent DIC

The KSPC's Drug Information Center has all the capabilities to help any organization set up a full fledged DIC of its own. KSPC's team would help you with all that is needed for setting up a DIC for the benefit of patients and common public. The same could also be used by other healthcare professionals.

Drug Queries

The DIC helps with the following type of queries

Clinical use/Place in therapy

All the clinical uses of drugs and medicines and their place in therapy.

Identification

We help in identification of the side-effects or adverse events

Costs
Dosage
Dose adjustments in kidney disease, liver disease patients etc.
Administration/IV compatibility
Pharmacokinetics
Mechanism of Action
Use in special population like Pediatrics, Geriatrics, Pregnancy, Lactation, Dialysis etc.
Effects of Isoniazid + Rifampicin+ Pyridoxine on fetus during first trimester in pregnancy.

A 28 yrs old female patient was diagnosed with Extrapulmonary Tuberculosis (Lymphnode at neck) and was on following medications, i.e, Tablet Isoniazid, Rifampicin and Pyridoxine. During the course of treatment (3rd month) she was confirmed with pregnancy (7th week). The gynecologist asked the patient to contact our DIC for the effects of above tablets on fetus during first trimester.

Comments: Isoniazid and Rifampin, is considered to be relatively safe for both the mother and the fetus for treating active tuberculosis infection in pregnancy. Although a clear causal relationship has not been established, pulmonary tuberculosis infection itself has been associated with a significantly higher frequency of miscarriage. There are also case reports of infants with congenital tuberculosis and drug-resistant disease may present an increased risk to the fetus. Careful clinical and laboratory monitoring for hepatitis is recommended.

Pyridoxine supplementation (25 milligrams/day) is recommended for all women taking isoniazid who are either pregnant or breastfeeding.

When rifampin is given during the last several weeks of pregnancy, chances of postnatal hemorrhages may occur in the mother and infant.

The American Thoracic Society recommends use of the anti-TB drugs for tuberculosis occurring during pregnancy because, "Untreated tuberculosis represents a far greater hazard to a pregnant woman and her fetus than does treatment of the disease".

Effect of Tablet Flutamide 250mg and Spironolactone 25 mg on fetus during first trimester

Patient History: Age: 26 years, Wt: 60kg, Disease: Polycystic Ovary Disease (PCOD) became pregnant and has taken the said drugs for 3months in her first trimester.

Polycystic Ovary Disease (PCOD) is a hormonal disorder problem in women.

The symptoms include changes in the menstrual cycle, acne, obesity, ovarian cysts, development of male characters like increased hair growth on face and other parts of the body (Hirsutism) due to increased male hormones, infertility and other problems.

Flutamide- It is an oral nonsteroidal antiandrogen (male hormone) drug primarily used to treat prostate cancer. It may also be used to treat excess androgen levels in women.

Antineoplastic agents are drugs that can cross placental barrier and thus can affect the life or quality of life of the fetus. However adequate data specifically on Flutamide is not available. But decreased survival time in offspring, feminization of male fetuses, skeletal malformations have been reported from animal studies.

Spironolactone: It is a potassium sparing diuretic. It is also used as an antiandrogen. Potassium-sparing diuretics are not recommended for use during pregnancy. Adequate study reports on humans are not available.

In animals, spironolactone has known endocrine effects, including progestational and antiandrogenic effects. Studies in animals have shown an increased occurrence of fetal damage.

Conclusion: Both the drug causes abnormal effects on the fetuses. Possibility of skeletal malformations and sexual characters should be watched out.

Interactions-Drug-Drug, Drug- Food, Drug-Lab parameters
Patient wanted to know whether there are any interactions between steroids and Mometasone Furoate and Miconazole and any contraindication to take seasonal influenza vaccine.

Patient History: A patient was diagnosed with Myasthenia Gravis and on regular steroid medication 25mg per day. Recently the patient had some fungal infection and was prescribed ELICA -M, Mometasone furoate (Ointment for the face) and MYCOHEAL; Miconazole Nitrate (ointment for the thighs).

Comments: Mometasone is a strong steroid and the safety and efficacy of this drug used longer than 3 weeks have not been established. If no response is seen within 2 weeks, treatment should be reassessed.

Miconazole nitrate can be used and there are no contraindications for seasonal influenza vaccine during steroid treatment.

Seasonal influenza vaccine recommended in: All person's age 6 months or older wanting to reduce the likelihood of becoming ill with influenza or of transmitting it to Adults age 50 years or older. Children and teens age 6 months through 18 years

Incompatibilities
Contraindications
Precautions
Side effects/Adverse Drug Reactions
Tablet Combiflam induced vomiting and rashes.

Case H/o: We had an adult reporting within few hours after consuming one tablet of Combiflam, with vomiting and rashes all over the body. Is this reported with this drug and if so how common is the same.

A. Tab Combiflam contains Ibuprofen 400 mg and Paracetamol 325 mg.

Literature studies show that vomiting and rashes has been reported with oral ibuprofen.

The incidence of nausea and/or vomiting reported with oral ibuprofen is 1% to 3% and the incidence of rash reported is 3% to 9%.

There are no reports of oral paracetamol induced vomiting and rashes. But there are reports of IV paracetamol induced vomiting and rashes in adults as well as pediatric patients. Based on the given history and literature studies, Ibuprofen can be suspected for vomiting and rashes in this patient.

Side effects and Drug interactions of Clobazapam and Oxcarbazepine tablet.

Clobazapam is reported to cause the following neurologic effects like dysarthria, ataxia, Insomnia, Lethargy, Sedated, Somnolence.

Oxcabazepine is known to cause the following neurologic side effects which include abnormal gait, Amnesia, Asthenia, Ataxia, Confusion, Dizziness, Feeling nervous, Headache, Impairment of balance, Insomnia, Metabolic encephalopathy, Neurological symptom, Nystagmus, Seizure, Seizure, Aggravated, Somnolence, Status epilepticus, Tardive dyskinesia, Tremor, Vertigo.

In this patient clobazapam can be suspected for slurred speech and very low voice since from the literature studies, it is reported to cause 2-5% incidences of dysarthria.

Kindly discuss with the respective physician for any change in therapy.

Storage & Stability

How to store H1N1 vaccines?

H1N1 (hemagglutinin –H, neuraminidase –N) vaccine is developed chick embryo to protect against the H1N1 virus infection. It is also developed from tissue culture technology.

Two types of H1N1 vaccines are available:

Injectable vaccine containing inactivated (killed) influenza virus is available in liquid form.

Nasal spray vaccine (sometimes called LAIV for Live Attenuated Influenza Vaccine) contains live, weakened viruses in dry powder form. This should be reconstituted as per the manufacturer's instruction.

Storage:

H1N1 vaccine like any other vaccine is thermo sensitive and needs to be preserved and transported under a good cold-chain system. It is also photosensitive and hence should be stored in original packing.

H1N1 vaccines (injectable & nasal spray forms) should be stored and maintained between 20 C and 80 C (35°F to 46°F) to maintain its potency till its date of expiry.

The reconstituted injectable vaccine should be also stored between 20 C and 80 C (35°F to 46°F). However, the reconstituted H1N1 vaccine maintains its potency at room temperature for 24 hours.

Specifically store H1N1 vaccine in the center of the refrigerator away from the walls and the doors of the refrigerator, as soon as it is received from the vendor.

Bottom-line: Potency can neither be assured nor expected if there is a failure in Cold-chain management. H1N1 vaccines should not be stored in the freezer. H1N1 vaccines should not be stored at below 20C or above 80C Preserve in the original packing.Avoid preservation of reconstituted vaccine and use it at the earliest.

Toxic reactions
Poison information
Calculation of Body Mass index
Calculation of ideal body weight
Patient counselling
Mechanism of Tab. Glyomet in body.

Patient History: Age: 76 ; H/o : DM from past 1 ½ yrs ; On tab. Glycomet (metformin hydrochloride) two times a day.

Mechanism:

Decreases liver glucose production and intestinal absorption of glucose. Increases peripheral glucose uptake (depending upon the metabolic needs of the tissue), utilization by improving insulin sensitivity of body tissues.

Metformin helps the body to control blood sugar in several ways. The drug helps type 2 diabetic patients to respond better to their own insulin present available in the body, lower the amount of sugar created by the liver and decreasing the amount of sugar absorbed by the intestines.

When taken alone, Metformin is unlikely to cause hypoglycaemia or weight gain, but when taken in conjunction with insulin or a sulfonylurea both of these side effects are more likely.

Drug Therapy Guidance:

Current and alternative therapy recommendations based on literature analysis and patient data are provided. Eg: drug use without indication, untreated indication, wrong/inappropriate drug selection, less dose of drugs used, overdosage, cost evaluation, Drug use in Pregnancy/ Lactation/ Pediatrics/ Geriatrics etc.

Evaluation of Adverse Drug Reactions:
Suspected adverse drug reactions are assessed.
Evaluation of Drug Interactions:

The significance of a drug-drug, drug-food, drug-disease or drug laboratory test interaction is evaluated.

Drug Administration, route, admixtures
Identification of equivalents for foreign brands:

The DIC attempt to identify drugs obtained in other countries. When possible the DIC will provide product composition and US equivalent.

Designing Dosage schedules:

Compliance or noncompliance of the patient to the therapy. Drugs use in terms of dose, dosing interval, and duration of treatment.

Poison information/Toxicology:

Provide information regarding toxic compounds and the management of poisoned patients.

Patient Counseling

Provide information on correct use of medicines to the patients or their representatives. This includes the directions of use, advice on side effects, precautions, storage, diet and life style modifications & any other relevant information about the illness.

Continuing Education Programme:

Conduct seminars, workshops and training programs to the pharmacists, healthcare professionals including medical doctors since 2000 periodically.

DIC newsletter –Publishing since Oct-Dec 1999

KSPC released the first issue of DIC Newsletter in October 1999. Read more….